Emergency departments are chaotic environments in which complex, frail older persons living in the community and residential aged care facilities are sometimes subjected to prolonged emergency department lengths of stay, excessive tests and iatrogenic complications. Given the ageing population, the importance of providing appropriate, quality health care in the emergency department for this cohort is paramount. One possible solution, a nurse-led, physician-championed, emergency department gerontological intervention team, which provides frontload assessment, early collateral communication and appropriate discharge planning, has been developed. The aim of this Geriatric Emergency Department Intervention is to maximise the quality of care for this vulnerable cohort in a cost effective manner.
The Geriatric Emergency Department Intervention research project consists of three interrelated studies within a program evaluation design. The research comprises of a structure, process and outcome framework to ascertain the overall utility of such a program. The first study is a pre-post comparison of the Geriatric Emergency Department Intervention in the emergency department, comparing the patient-level outcomes before and after service introduction using a quasi-experimental design with historical controls. The second study is a descriptive qualitative study of the structures and processes required for the operation of the Geriatric Emergency Department Intervention and clinician and patient satisfaction with service models. The third study is an economic evaluation of the Geriatric Emergency Department Intervention model of care.
There is a paucity of evidence in the literature to support the implementation of nurse-led teams in emergency departments designed to target frail older persons living in the community and residential aged care facilities. This is despite the high economic and patient morbidity and mortality experienced in these vulnerable cohorts. This research project will provide guidance related to the optimal structures and processes required to implement the model of care and the associated cost related outcomes.
Australian New Zealand Clinical Trials Registration Number is 12615001157561. Date of registration 29 October 2015.
Australian Institute of Health and Welfare. Older Australians at a glance, vol. 2 Cat. no. AGE 52. 4th ed. Canberra: AIHW; 2007.
Productivity Commission. Caring for older Australians, report No 53, final inquiry report: Canberra. 2011.
Wilber ST, Gerson LW, Terrell KM, Carpenter CR, Shah MN, Heard K, Hwang U. Geriatric emergency medicine and the 2006 institute of medicine reports from the committee on the future of emergency care in the U.S. Health system. Acad Emerg Med Off J Soc Acad Emerg Med. 2006;13(12):1345–51. CrossRef
Crilly JC W, Wallis M. Continuity of care for acutely unwell older adults from nursing homes. Scand J Caring Sci. 2006;20:122–34. CrossRef
Crilly J, Chaboyer W, Wallis M, Thalib L, Green D. Predictive outcomes for older people who present to the emergency department. Aust Emerg Nurs J. 2008;11(4):178–83. CrossRef
Hastings SN, Heflin MT. A systematic review of interventions to improve outcomes for elders discharged from the emergency department. Acad Emerg Med Off J Soc Acad Emerg Med. 2005;12(10):978–86. CrossRef
Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. JAGS. 2003;51(4):549–55. CrossRef
Coleman EA, Boult C. American Geriatrics Society Health Care Systems C: Improving the quality of transitional care for persons with complex care needs. JAGS. 2003;51(4):556–7. CrossRef
Schnitker L, Martin-Khan M, Beattie E, Gray L. Negative health outcomes and adverse events in older people attending emergency departments: a systematic review. Australas Emerg Nurs J. 2011;14(3):141–62. CrossRef
Glickman SW, Cairns CB, Otero RM, Woods CW, Tsalik EL, Langley RJ, van Velkinburgh JC, Park LP, Glickman LT, Fowler Jr VG, et al. Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis. Acad Emerg Med Off J Soc Acad Emerg Med. 2010;17(4):383–90. CrossRef
Caterino JM, Kulchycki LK, Fischer CM, Wolfe RE, Shapiro NI. Risk factors for death in elderly emergency department patients with suspected infection. JAGS. 2009;57(7):1184–90. CrossRef
Carusone SC, Loeb M, Lohfeld L. Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives. BMC Geriatr. 2006;6(2):1–9.
Shepperd S, Iliffe S, Doll HA, Clarke MJ, Kalra L, Wilson AD, Gonçalves-Bradley DC. Admission avoidance hospital at home. Cochrane Database of Syst Rev. 2016(9)Art. No.: CD007491. doi: 10.1002/14651858.CD007491.pub2.
Finn JC, Flicker L, Mackenzie E, Jacobs IG, Fatovich DM, Drummond S, Harris M, Holman DC, Sprivulis P. Interface between residential aged care facilities and a teaching hospital emergency department in Western Australia. Med J Aust. 2006;184(9):432–5. PubMed
Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department - the DEED II study. JAGS. 2004;52(9):1417–23. CrossRef
Burkett E, Scott I. CARE-PACT: a new paradigm of care for acutely unwell residents in aged care facilities. Aust Fam Physician. 2015;44(4):204–9. PubMed
Smith SM, Wallace E, O’Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database of Systematic Reviews. 2016(3) Art. No.: CD006560. doi: 10.1002/14651858.CD006560.pub3.
Pearce S, Rogers-Clark C, Doolan J. A comprehensive systematic review of age-friendly nursing interventions in the management of older people in emergency departments. JBI Library Syst Rev. 2011;9(20):679–726.
Sunshine Coast and Hospital Health Service. In: Health Q, editor. Health service plan - 2012-2022. 2012.
Creswell JW. Research Design: qualitative, quantitative, and mixed methods approaches. 4th ed. UK: Sage; 2014.
Donabedian A. Evaluating the quality of medical care. Milbank Q 2005. 1966;83(4):691–729.
Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. U.S.A.: Houghton Mifflin; 2002.
Australasian College for Emergency Medicine. Guidelines for the Implementation of the Australaisian Triage Scale. Melbourne, VIC: 2013. Report No.: G24.
Australian Commission on Safety and Quality in Health Care. (2010) Adult Deterioration Detection System (ADDS) chart. From http://www.health.gov.au/internet/safety/publishing.nsf/Content/RaRtCD_EBA-GOC. Accessed Feb 2016.
Barnett AG, Dobson AJ. Analysing seasonal health data. Berlin: Springer; 2010. CrossRef
von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. CrossRef
Irvine D, Sidani S, Hall LM. Finding value in nursing care: a framework for quality improvement and clinical evaluation. Nurs Econ. 1998;16(3):110–6. 131. PubMed
Bogdan R, Biklen SK. Qualitative research for education: an introduction to theory and methods. 4th ed. New York: Pearson Education Group; 2003.
Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. London: Sage Publications; 1994.
Oliver D, Roos J. Constructing organizational identity. Switzerland: Imagination Lab Foundation; 2004.
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